This includes considering GLP-1 receptor agonists like Rybelsus for people with type 2 diabetes who have a body mass index (BMI) of 35 kg/m or higher (or 32.5 kg/m or higher for those of South Asian or Chinese descent) and who would benefit from weight loss, or when insulin therapy would have significant occupational implications or weight gain would cause significant clinical or psychological problems
There is some previous evidence for GLP-1s used to treat type 2 diabetes moderately reducing major cardiovascular events and all-cause mortality
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Potential risks include: Enhanced gastrointestinal side effects (nausea, vomiting, diarrhea, constipation) Increased risk of nutritional deficiencies and protein malnutrition Potential worsening of gastroesophageal reflux symptoms Dehydration risk and acute kidney injury, particularly during dose escalation Increased risk of gallbladder disease and complications Risk of intestinal obstruction or ileus Diabetic retinopathy progression in patients with diabetes, particularly with rapid glycemic improvement Hypoglycemia risk, particularly in patients on insulin or sulfonylureas Cost considerations and insurance coverage challenges Rare but serious risks including pancreatitis and thyroid C-cell tumors (boxed warning) Clinicians must engage in shared decision-making with patients, carefully weighing these potential benefits against risks in the context of individual patient circumstances, surgical outcomes, comorbidities, and treatment goals
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